Successful implementation of computerized physician order entry (POE) is a prerequisite for successful implementation of the computer-based patient record. Preliminary studies indicate that POE is neither widespread nor heavily used in the U.S. and that the reasons for lack of diffusion go well beyond physician recalcitrance. Prior research on POE primarily includes case studies by closely involved parties. This FIRST award proposal for a new investigator outlines a systematic cross-institutional study involving objective outside researchers. The researchers have many years of experience working together as an interdisciplinary team, and have completed extensive preliminary work. This study will provide further evidence about reasons for lack of diffusion of POE by identifying factors which have caused a number of sites that have implemented POE to do so successfully and not so successfully. A consensus panel will then be convened to study the evidence and develop recommendations for POE implementation. The POE consensus statement will be validated in the field using qualitative techniques and, after modification, will be disseminated in both printed and digital form for wide access. The specific aims are: AIM 1. Gather the evidence: using qualitative techniques, study the implementation of POE at four sites in the U.S. in sufficient depth that success and failure factors can be identified. Method: Informal and formal interviews and shadowing of residents, attendings, and clinicians (including nurses, clinical pharmacists, and physicians) at the Seattle and American Lake divisions of the Puget Sound Veterans Affairs Health System, El Camino Hospital, and Kaiser Permanente Northwest. All interview and other qualitative data will be analyzed and interpreted by three researchers. AIM 2. Evaluate and interpret the evidence: convene a Consensus Panel to develop a statement to be titled "An Integrated Approach to Physician Order Entry Implementation." Method: Bring together a panel of experts for the purpose of reaching consensus on recommendations for the successful implementation of POE. The Oregon team will blend in its findings with the opinions of other recognized experts. The panel will produce a document which will include the following: how to assess the organization's readiness for POE; how to implement POE in different settings; the roles of information technology, clinician, and informatics professionals in implementation; directions for the future; and conclusions. AIM 3. Validate and disseminate the document: select and visit at least three sites with recent POE implementations to validate the Consensus Statement. Method: Using similar qualitative methods to those in Aim 1, visit different study sites during implementation of POE to discover if the consensus statement is valid. The consensus statement will be modified if necessary and will be published in media that will reach a broad audience, including those using the World Wide Web.